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EAP Member
Information
covid-19 special II

SPECIAL PROGRAMS AND GUIDELINES
concerning the new and challenging way
to work during COVID-19 crisis

Dear EAP colleagues,

We wanted to give you an update on current developments in the psychotherapy field relating to the challenges brought about by the Covid-19 pandemic. While situations and the extend of “lock-down”, travel restrictions, or “social distancing” vary geographically across Europe, these will remain fluid (and subject to change at short notice) and can be expected to continue for the immediate foreseeable future. EAP has received a number of concerns regarding aspects of psychotherapy during the pandemic, ranging for example from advertising concerns to the safety of online group psychotherapy. 

In this unprecedented situation, psychotherapists can be reasonably expected to seek a good balance between expanding or adapting their prior clinical practice and exploring how to include new ways of working, such as online psychotherapy for example, in response to clients/patients and students needs for support and continuity. On the other hand, the virus pandemic does not change or invalidate the long established EAP Ethical Principles about advertising in any way. And while it may well be in the best interest to continue an existing psychotherapy group in a virtual online space if the group chooses to do so, the starting of a new group via online media without prior experience may be an ill-advised and perhaps irresponsible initiative during the Covid-19 pandemic. When in doubt, supervision is always a first starting point to explore our concerns or any new challenges we meet. In addition however, we do have the well established format in psychotherapy to seek a “consultation” with a senior colleague who can draw on relevant experience or knowledge to help us explore any concerns or challenges we face. And we may also seek a “second opinion” when questions remain about any recommendations or advice we receive.

The practice of psychotherapy has always been a venture into the unknown, a venture into uncharted waters, whilst making great efforts to facilitate such endeavours safely, ethically and with robust accountability. Keeping our clients, patients, students, supervisees and indeed ourselves safe and well supported must always be a guiding principle in any circumstances.

With good wishes at these challenging times

Tom Warnecke,

May 2020
IINFORMATION AND LINKS
relevant to psychotherapy practice
during the Covid-19 pandemic

There is a growing number of initiatives set up locally by psychotherapists with the aim to support medical staff (or indeed other frontline care or keyworker staff) who work in often very stressful frontline positions during, or in response to, the Covid-19 crisis. These psychotherapy initiatives typically offer a limited number of free online support sessions, some of them as brief as 20 minutes for instance. I include three links to such projects as examples on how such initiatives might be structured and framed. 

The first one is an Italian project (the link leads to an English language introduction) (https://iaap.org/announcements/news/psychological-aid-for-victims-of-the-corona-virus-in-italy/). The second is a UK project (https://relationalschool.wordpress.com/we-see-you-we-hear-you-nhs-staff/ ), and the third a US based one (https://www.nyctrn.org)

PESI-UK, the online CPD provider EAP has teamed up, have given us a free link to a Covid-19 talk by the well know trauma researcher Bessel van der Kolk: Steering ourselves and our clients through new and developing trauma. You can watch this talk at: https://bit.ly/3ceOlHc

PESI-UK are also scheduling a weekly free 60 minute online event at 17.00 GMT (18.00 CET) every Thursday. For technical reasons, participation is limited to 3000. Please check the PESI-UK website (https://www.pesi.co.uk/) for the current programme and how to reserve a place. PESI-UK are also planning a series of online Covid-19 relevant events for Mental Health Awareness Week which is scheduled for 18-24 May 2020.

Taylor & Francis, the publishers of international Body, Movement and Dance in Psychotherapy journal, have made a key article about Hypo-responses (particularly relevant when working with clients/patients impacted by the pandemic) available for free download until June. The article is by Merete Holm Brantbjerg with the title ‘Widening the map of hypo-states: a methodology to modify muscular hypo-response and support regulation of autonomic nervous system arousal’ and can be read or downloaded here:  https://www.tandfonline.com/doi/full/10.1080/17432979.2019.1699604

Fresh off the press is an article published in the Guardian newspaper ‘Patterns of pain: what Covid-19 can teach us about how to be human’ at https://t.co/8bi1VnMTYW by Susie Orbach in which she explores the psychological difficulties we might expect to see when people come out of lockdown situations.

Please contact the EAP newsletter team if you have any information that might be relevant to the wider EAP psychotherapy community.

Tom Warnecke

May 2020
COVID-19 IN ITALY

Italy, the first European country hard hit by Covid-19, has activated various free services to respond to requests for psychological support from the population and health professionals, either by telephone or on online. These services are made available by: Civil Protection, Red Cross, National Council of the Order of Psychologists and Doctors and Ministry of Health.

In particular, the Ministry of Health has involved and is coordinating the Scientific Societies, including the FIAP, to offer free listening and consultancy service aimed at children, teenagers, adults, couples, families and healthcare professionals. These services are provided by professionals of different psychotherapeutic orientations.  

In addition, many colleagues working in the private sector, both psychologists and psychiatrists, have made themselves available to citizens, also free of charge.

The COVID-19 emergency is generating serious economic problems for our country and for our freelance professionals. Despite the fact that psychotherapists are a healthcare profession and therefore could have continued to see patients in the studio even during the lockdown, many colleagues decided to close their studies and suggest an online setting, in order to safeguard both themselves and the patients. However, many patients preferred to discontinue psychotherapy and did not accept the online option. This was generally for two reasons:

  • the inability to find the necessary privacy at home 
  • dislike of the online setting

Member associations of FIAP are working to establish the necessary guidelines to face the specific situation of secondary trauma resulting from the pandemic.

Luisa Martini

Il Presidente della FIAP
COVID-19 NEWS
from the Austrian NUO (ÖBVP)

At the beginning of the Corona crisis, the Presidium of the Austrian Professional Body (ÖBVP) was able to negotiate important regulations with the government and the social insurance to maintain psychotherapeutic care even during the restrictions and quarantine measures.

Treatments via the telephone and the Internet have been explicitly approved and may be called psychotherapy for the duration of the pandemic (Ministry of Health in March 2020). The Social Insurance decided to value telephone and internet treatment as if this therapy had taken place in the practices. The professional body also tried to put a protective shield over psychotherapists. It was negotiated with the government that psychotherapists who face economic difficulties as a result of the shutdown will benefit from numerous government financial emergency measures and corona-related loss of income will be cushioned. Some colleagues have already received financial aid from the state.

With the help of fact sheets, newsletters, etc., Austrian psychotherapists were regularly kept up to date on all government measures to contain the Coronavirus and on the effects on practices. Uncertainty among psychotherapists could be kept to a minimum by providing quick information. Further assistance ranges from training for video-based sessions or the free distribution of masks to the members of the ÖBVP.

Another bundle of measures concerns the care and information of patients. Various psychotherapeutic hotlines were set up, information for the population was promoted through media releases and a notice board was made available to colleagues. Due to the close contact with the ministries, psychological issues were considered. Further measures are being prepared, with particular care for risk groups such as the elderly.

The cooperation of the professional body with public bodies, the networking with the official crisis teams and the contributions to mental health in difficult times also prepare a basis for the time after the crisis.

Karl-Ernst Heidegger

EAP-Delegate of the Austrian Association for Psychotherapy (ÖBVP)
COVID-19 INITIATIVES IN SPAIN
What we do here in Spain:

First: we inform our members the better ways to connect online with their patients.

Second: We prepare an online intervention to give therapeutic support to our Sanitary colleagues that were fighting with this terrible virus and very new and angst situation for medicals, nurses and any person working in hospitals. We call our initiative “WE ARE YOUR SECOND LINE” and at the moment we have more than 150 psychotherapists working free in this support. On line of course!!

Find here the poster placed in every hospital or sanitary center in Spain.

Joseph Knobel Freud

Spanish Delegate
SLOVENIA: The SKZP
Working Group for Psychosocial Support
At the onset of the COVID-19 epidemic and the consequent emergency measures in Slovenia the Executive Committee of the Slovene Umbrella Association for Psychotherapy (SKZP) made a decision to form the Working Group for Psychosocial Support, supported by the agreement of the Professional Committee. The Working Group is managed by its leader and the coordination group which is subdivided into the communication group, the group for ethical and professional guidelines and the group for contacting other organizations. The latter coordinates the volunteers within the ranks of SKZP to them.  

We decided to offer psychosocial help contact via telephone. For this purpose we connected with the Red Cross which at our initiative opened a new line. Together with the SFU Ljubljana we are cooperating with the Municipality of Ljubljana which did the same. We have also established a connection with The Association of Psychologists of Slovenia which has opened its own line in cooperation with the National Institute for Public Health. 

As we didn't have much experience or knowledge with offering this kind of support, we contacted our colleagues in Croatia, who kindly provided us with the material. We published the translation of their manual 'Hello, help!' on our website, together with other material for the SKZP volunteers and guidelines for self-help for the general public. We are especially proud of the infographics for all the available psychosocial support in Slovenia. We managed to get sponsorship for it and it will soon be available for free on our website.

At the moment there are many more volunteers (120) than there are phone calls from people in distress. So we are in the process of looking for more ways to reach the public with information about our availability. We are also searching for other possibilities for reaching out to people in distress. For example, the Red Cross is now creating a new project to help children from disadvantaged families in their school tasks and lessons from home. Our volunteers are taking part in this project.

Tomaž Flajs

Vice President of SKZP
and the leader of its Working Group for Psychosocial Support
LONDON, UK: Family therapy
supervision sessions using Zoom

My family therapy trainee group of Masters’ students nearing the end of their training at the Tavistock Centre in London have been continuing to offer therapy by Zoom during the Covid 19 crisis under my supervision. We communicated with families with the following message:

In the light of current concerns about the spread of the Corona Virus and the need for reduced social contact how would you feel if we continued seeing you for family therapy sessions virtually using Zoom? The alternative is to suspend therapy until the crisis is over and check in with you occasionally by telephone. 

Before you decide, in consultation with other members of your family, whether to take up this offer, may I explain that the observing team will still be present remotely, switching off their video cameras and muting their microphones until we invite them to offer their reflections just as we do when we see you face to face. During the session we ask you to minimise interruptions by switching mobile telephones to silent mode and remaining together in the room as if you were with us at the Tavistock. As the Zoom session only lasts for 40 minutes at a time, before cutting out, we will start the second part of the session with reflections from the team. During the reflections we ask family members to mute their microphones We look forward to hearing your response.


We have held, at the time of writing, four successful sessions with three different families using Zoom with only minor technical difficulties, when an observing supervisee had unstable connectivity for example. One can recreate conditions which are very close to those of face to face work. Even discussions behind the screen can continue using Whatsapp messages between the supervisor and the trainees watching their colleague see the family. This is a way to feed in ideas so that the supervisor can offer an impromptu intervention, interrupting just like a telephone call or a knock on the door. We have also been recording the sessions for the purpose of video review using the We Transfer app to send recordings securely to each other. 

One interesting difference is how Zoom allows all parties to see the faces of each member of the Reflecting Team observer. From our limited anecdotal experience this appears to make the intervention a more intense and powerful. 

We are collating experiences of family therapy group supervision using Zoom and other applications and are keen to hear how other supervision groups around Europe have been adapting their practice in the lockdown. For correspondence about Zoom supervision please email me at damias@tavi-port.nhs.uk 

David Amias

Consultant Systemic Psychotherapist
Tavistock Centre, London

With thanks to family therapy trainees Michaela Wickham-Hills, Julie Berentsen, Patrick Bates and Rhodie Thomas
COVID-19 NEWS from the
Irish Council for Psychotherapy (ICP)

I have a reasonable grip on and knowledge of Zoom and other technologies and still I find it challenging working in this way. My practice is in a small country town and many clients live where there is no broadband and or wifi that can be unreliable. It can drop in the middle of a session. My contingency for this is to suggest to the clients that if this happens, we will continue by telephone. I find this loss of control over the psychotherapeutic environment difficult. Some of the challenges for the clients are: no safe space to have psychotherapy on line; a fear of the unknown; a fear of death and in many cases no income and maybe none in the future.

Some clients would have just begun psychotherapy and don’t want to engage online. Others find it strange and the holding of this is challenging. I find my eyes are sore at the end of the day and even though I am seeing less clients I am very tired. The sessions can be very intimate in that the virtual space is very small. Some clients are trying to cope without psychotherapy and then find themselves returning to the process after a few weeks. I am grateful that I can continue to work regardless of all of this and encourage clients to look to what they can do, look at a good film, read, play with children and grandchildren, sing and paint. I have taken to singing and writing and find it soothing.  

The positive part of Covid-19 is the generosity of others in supporting and sharing their time and talents and their sense of humour in the middle of this trauma. I have had many offers of kindness and I am very touched. Self-compassion and self-care need to be high on our priority list at the moment. There is also an opportunity to re-evaluate our lives. 

Anne Colgan

Chair ICP

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Best wishes from

Ingrid & Anne

Marketing Group, news@europsyche.org
 
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